P9573 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT
Owner/Occupant L a. F r V D ti n ly L
Address �%� /41 d C Ir -3'c, rZl
SEPTIC TANK PERP,1IT Date /G' --5-� 7�
Address R27 `g /�l ty C
Building Contractor Address
Gal. 6 0 Manufacturer's NameS�ar� G ra �-IGQddress & "'y ' j o c rS a zz'
No. of lines _�_ Width 3 in. Total length 1-77 ft. No. sq. ft.
i
Type of filter material Total tons used d S /�
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
Date of Final Approval /0 S�� %j' Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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